Risk classification system using the detailed positive surgical margin status for predicting biochemical recurrence after robot-assisted radical prostatectomy.

IF 1.4 4区 医学 Q4 ONCOLOGY
Tomoya Hatayama, Keisuke Goto, Kenta Fujiyama, Akihiro Goriki, Mayumi Kaneko, Koji Mita
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Abstract

Aim: This study aimed to evaluate the risk classification system using the detailed positive surgical margin (PSM) status to predict biochemical recurrence (BCR) after robot-assisted radical prostatectomy (RARP).

Methods: We retrospectively analyzed 427 patients who underwent RARP between January 2016 and March 2020. We investigated risk factors for BCR using univariate and multivariate Cox proportional hazard regression models. The biochemical recurrence-free survival (BRFS) rate was assessed using the Kaplan-Meier method.

Results: The median follow-up period was 43.4 months and 99 patients developed BCR. In the multivariate analysis, maximum PSM length > 5.0 mm and the International Society of Urological Pathology grade group (ISUP GG) at the PSM ≥3 were predictive factors for BCR in patients with a PSM. In the multivariate analysis, these factors were also independent predictive factors in the overall study population, including patients without a PSM. We classified the patients into four groups using these factors and found that the 1-year BRFS rates in the negative surgical margin (NSM) group, low-risk group (PSM and neither factor), intermediate-risk group (either factor), and high-risk group (both factors) were 94.9%, 94.5%, 83.1%, and 52.9%, respectively. The low-risk group showed similar BRFS to the NSM group (p = 0.985), while the high-risk group had significantly worse BRFS than the other groups (p < 0.001).

Conclusion: Maximum PSM length > 5.0 mm and ISUP GG at the PSM ≥3 were independent predictive factors for BCR after RARP. Risk classification for BCR using these factors is considered to be useful and might help urologists decide on additional treatment after RARP.

Abstract Image

利用详细的阳性手术切缘状态预测机器人辅助根治性前列腺切除术后生化复发的风险分类系统。
目的:本研究旨在评估使用详细的手术切缘阳性(PSM)状态预测机器人辅助前列腺癌根治术(RARP)后生化复发(BCR)的风险分类系统:我们对2016年1月至2020年3月期间接受RARP的427例患者进行了回顾性分析。我们使用单变量和多变量 Cox 比例危险回归模型研究了 BCR 的风险因素。采用卡普兰-梅耶法评估了无生化复发生存率(BRFS):结果:中位随访期为 43.4 个月,99 例患者出现了 BCR。在多变量分析中,最大 PSM 长度大于 5.0 mm 和 PSM 处的国际泌尿病理学会分级组(ISUP GG)≥3 是 PSM 患者 BCR 的预测因素。在多变量分析中,这些因素也是包括无 PSM 患者在内的总体研究人群的独立预测因素。我们利用这些因素将患者分为四组,发现手术切缘阴性组(NSM)、低风险组(PSM 和两个因素均不存在)、中风险组(任一因素)和高风险组(两个因素均存在)的 1 年 BRFS 率分别为 94.9%、94.5%、83.1% 和 52.9%。低风险组的 BRFS 与 NSM 组相似(p = 0.985),而高风险组的 BRFS 明显差于其他组(p 结论:低风险组的 BRFS 与 NSM 组相似(p = 0.985):最大 PSM 长度 > 5.0 mm 和 PSM 处 ISUP GG ≥ 3 是 RARP 后 BCR 的独立预测因素。利用这些因素对 BCR 进行风险分类被认为是有用的,可帮助泌尿科医生在 RARP 后决定是否进行其他治疗。
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来源期刊
CiteScore
3.40
自引率
0.00%
发文量
175
审稿时长
6-12 weeks
期刊介绍: Asia–Pacific Journal of Clinical Oncology is a multidisciplinary journal of oncology that aims to be a forum for facilitating collaboration and exchanging information on what is happening in different countries of the Asia–Pacific region in relation to cancer treatment and care. The Journal is ideally positioned to receive publications that deal with diversity in cancer behavior, management and outcome related to ethnic, cultural, economic and other differences between populations. In addition to original articles, the Journal publishes reviews, editorials, letters to the Editor and short communications. Case reports are generally not considered for publication, only exceptional papers in which Editors find extraordinary oncological value may be considered for review. The Journal encourages clinical studies, particularly prospectively designed clinical trials.
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